What is the recommended dose of acyclovir (antiviral medication) for a 14-month-old child?

Acyclovir Dosing for a 14-Month-Old Child

For a 14-month-old child, the recommended dose of oral acyclovir is 20 mg/kg per dose (maximum 400 mg per dose) administered three times daily for 5-10 days, depending on the type of herpes simplex virus infection being treated. 1

Dosing Guidelines by Condition

Mild Herpes Simplex Virus Infections

• Oral acyclovir: 20 mg/kg body weight per dose (maximum 400 mg/dose) administered 3 times daily 2, 1
• Duration: 5-10 days or until lesions completely heal 1

Moderate to Severe Infections

• Initial treatment: Intravenous acyclovir 5-10 mg/kg body weight per dose 3 times daily 2
• Transition to oral therapy: Once lesions begin to regress, switch to oral acyclovir at the dose mentioned above 2
• Continue until: Complete healing of lesions 1

Specific Conditions

Gingivostomatitis (Oral Herpes)

• Mild: Oral acyclovir 20 mg/kg (maximum 400 mg) 3 times daily for 5-10 days 2, 1
• Moderate to severe: Initial IV acyclovir, then transition to oral therapy 2

Genital Herpes

• Oral acyclovir: 20 mg/kg (maximum 400 mg) 3 times daily for 5-14 days 2, 1

Chickenpox (Varicella)

• Oral acyclovir: 20 mg/kg (maximum 800 mg) 4 times daily for 5-7 days or until no new lesions for 48 hours 1

Important Considerations

Administration

• Proper weight-based dosing is essential to prevent subtherapeutic levels 1
• Treatment should begin at the earliest sign of viral blisters for maximum effectiveness 1
• Maintain adequate hydration during treatment 1
• Oral suspension may be more appropriate for a 14-month-old who may have difficulty swallowing tablets 1

Monitoring

• Watch for potential adverse effects, including:
  • Gastrointestinal symptoms
  • Headache
  • Rarely, neutropenia with prolonged use 1

Common Pitfalls to Avoid

1. Delayed treatment initiation: Start treatment at the earliest sign of viral blisters to maximize effectiveness 1
2. Inadequate dosing: Ensure proper weight-based dosing 1
3. Insufficient treatment duration: Continue until complete healing of lesions 1
4. Failure to adjust dosing as the child grows: Reassess dosing with significant weight changes 1
5. Using topical therapy alone: Systemic therapy provides better control of symptoms and signs of herpes episodes in children 1

Special Considerations

• For CNS or disseminated disease: Higher dose of 10 mg/kg IV 3 times daily for 21 days is required 2
• For patients with renal impairment: Dose adjustment is necessary as acyclovir is primarily eliminated by the kidneys 1
• Avoid topical corticosteroids in cases of suspected herpes simplex 1

By following these dosing guidelines, you can effectively treat herpes simplex virus infections in a 14-month-old child while minimizing the risk of adverse effects.